0 BAKERS ISLAND - LOT 90 - BUILDING INSPECTION I� 'BAKERS ISLAND LOT 90
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KEEPING YOU ORGANIZED
No. 10301
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WOE N UNI
W OMANIM At 91EAD.COM
No._;21SI City of Salem Ward
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APPLICATION
FOR
PERMIT TO BUILD ADDITION, MAKE ALTERATIONS OR NEW CONSTRUCTION
IMPORTANT•Applicant to complete all items in sections:1, ll, Ill, IV,and IX.
L p7r V'7 -Zg-&f I C 1r— d ZONING
I. AT(LOCATION) rj DISTRICT
LOCATION (NO.) s REETI
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS LOTETI
SUBDIVISION LOT BLOCK SIZE
II. TYPE AND COST OF BUILDING •All applicants complete Parts A -D
A. TYPE OF IMPROVEMENT D. PROPOSED USE-FOR"DEMOLITION"USE MOST RECENT USE
1 ❑ New building Residential Nonresidential
2 ❑ Addition(If residential,enter number of new 12 ❑ One family 18 ❑ Amusement,recreational
housing units added,if any,in part D, 13) 19 E] Chruch,other religious
13 E] Twoor more family-Enter number
3 ❑ Alteration(See 2 above) ofunits .._.._........... .....................
20 ❑ Industrial
21 ❑ Parking garage
4 Repair replacement 14 ❑ Transient hotel,motel,or dormitory- 22 ❑ Service station,repair garage
Enter number of units ...........................
5 ❑ Wrecking(h multifamily residential,enter number 23 ❑ Hospital,institutional
of units in building in Part D, 13) 15 ❑ Garage
24 ❑ Office,bank,professional
6 ❑ Moving(relocation) 16 ❑ Carport 25 ❑ Public utility
7 ❑ Foundation only26 ❑ School,library,other educational
17 Other-Specify L 27 ❑ Stores,mercantile
B.OWNERSHIP V
r28 ❑-Tanks,towers
8 CJ-YPrivate(individual,corporation,nonprofit
institution,etc.)
29 ❑ Other-Specify
9 ❑ Public(Federal,State,or local government
C.COST (Omit cents) Nonresidential-Describe in detail proposed use of buildings,e.g.,food processing plant,
machine shop,laundry building at hospital,elementary school,secondary school,college,
10. Cost of improvement ......................................................... $ O d parochial school,parking garage for department store,rental office building,office building
at industrial plant.It use of existing building is being changed,enter proposed use.
To be installed but not included
in the above cost
a. Electrical.........................---...........................................
b. Plumbing..........................................................................
c. Heating,air conditioning
d. Other(elevator,etc.).....................................................
11. TOTAL COST OF IMPROVEMENT $ soo
III. SELECTED CHARACTERISTICS OF BUILDING -For new buildings and additions, complete Parts E-L;demolition,
complete only Parts J&M,all others skip to IV
E. PRINCIPAL TYPE OF FRAME F. PRINCIPAL TYPE OF HEATING FUEL G. TYPE OF SEWAGE DISPOSAL I. TYPE OF MECHANICAL
30 ❑ Masonry(wall bearing) 35 ❑ Gas 40 ❑ Public or private company Will there be central air
31 ❑ Wood frame 36 ❑ Oil 41 ❑ Private(septic tank,etc.) conditioning?
32 ❑ Structural steel 37 ❑ Electricity 44 ❑ Yes 45 ❑ No
33 ❑ Reinforced concrete 38 ❑ Coal H. TYPE OF WATER SUPPLY Will there by an elevator?
34 ❑ Other-Specify 39 ❑ Other-Specify 42 ❑ Public or pnvate company 46 ❑ Yes 47 ❑ No
43 ❑ Private(well,cistern)
J.DIMENSIONS M. DEMOLITION OF STRUCTURES:
48. Number of stones ............................................................
as. total ors,square
on exterior feet of poor area,
all floors,baHas Approval from Historical Commission been received
dimensions ............................_..........._........................._ for any structure over fifty(50)years? Yes_ No_
50 Total land area,sq.n..................................................... Dig Safe Number
K.NUMBER OF OFF-STREET PARKING SPACES Pest Control:
51. Enclosed .............................................................................
HAVE THE FOLLOWING UTILITIES BEEN DISCONNECTED?
52. outdoors................._...................._._.._...._................... Yes No
L RESIDENTIAL BUILDINGS ONLY Water:
53. Enclosed.......................................-.................................... Electric:
Gas:
Full_.____......._. ._........._ Sewer:
54. Number of
bathrooms DOCUMENTATION FOR THE ABOVE MUST BE ATTACHED
Partial---. ...................-. BEFORE A PERMIT CAN BE ISSUED.
IV. COMPLETE THE FOLLOWING:
Historic District? Yes_ No—_!L (If yes, please enclose documentation from Hist. Com.)
Conservation Area? Yes_ No✓✓ (If yes, please enclose Order of Conditions)
Has Fire Prevention approved and stamped plans or applications? Yes_ No
Is property located in the S.R.A. district? Yes_ No✓
Comply with Zoning? Yes__J_ No_ (If no,enclose Board of Appeal decision)
Is lot grandfathered? Yes_ No (If yes„submit documentation/if no, submit Board of Appeal decision)
If new construction, has the proper Routing Slip been enclosed? Yes_ No_
Is Architectural Access Board approval required? Yes_ No✓ (If yes,submit documentation)
Massachusetts State Contractor License# p hal PUI, Salem License# CP"--A)
Home Improvement Contractor # 0 VJS--A,_ Homeowners Exempt form (if applicable) Yes J No
CONSTRUCTION TO BE COMMENCED WITHIN SIX (6) MONTHS OF ISSUANCE OF BUILDING PERMIT
_If an extension is necessary, please submit
CONSTRUCTION IS TO BE COMPLETED'BY” f( j 99 c/ in writing to the Inspector of Buildings.
V. IDENTIFICATION - To be completed by all applicants
Name Mailing address-Number,street,city,and state ZIP Code Tel.No.
Owner or
a I 11 P.O. 0 151 "Dun 4r2L) ol8a�- (,yq_cti I
Lessee O ISI
2.
Contractor
Builder's
License No.
3.
Architect or
Engineer
I hereby certify that the proposed work is authorized by the owner of record and that I have been authorized by the owner to make this application
as his authorized agent and we agree to conform to all applicable laws of this jurisdiction.
Signature of applicant AddressApplication date
P.0 ISI un5+ZbLu 0) x7 _ 1_ 9
DO NOT WRITE BELOW THIS LINE
VI. VALIDATION
Building _ /�'// FOR DEPARTMENT USE ONLY
Permit number j 7
Building Use Group
Permit issued 19 Fire Grading
Building
Permit Fee $ U—a Live Loading
Certificate of Occupancy $ Approved Occupancy wad
Drain Tile $ by:
Dian Review Fee $ Pat "
TITLE
NOTES AILItt JI—C 13 4P 2q
P
PERMIT TO BE MAILED TO:
DATE MAILED:
Construction to be started by: Completed by:
k
B
VI ZONING PLAN EXAMINERS NOTES
DISTRICT
USE
FRONT YARD
SIDE YARD SIDE YARD
REAR YARD
NOTES
SITE OR PLOT PLAN •For Applicant Use
oN